1. Field of the Invention
The present invention relates to a pharmaceutical composition for subcutaneous injection comprising a paliperidone compound. In particular the composition releases the paliperidone with an immediate onset of action and has an extended release time. Moreover, the present invention relates to a pharmaceutical composition for subcutaneous injection comprising a paliperidone compound in a certain concentration. The present invention also relates to use of the compositions as well as methods of treatment and a kit of parts.
2. Background
It is noted that citation or identification of any document in this application is not an admission that such document is available as prior art to the present invention.
Paliperidone is an atypical antipsychotic indicated for the acute and maintenance treatment of schizophrenia. The drug exhibits significantly reduced side-effects compared to other anti-psychotic drugs used to treat both schizophrenia as well as bipolar disorder.
Chemically, paliperidone is 9-hydroxyrisperidone. Paliperidone and risperidone act via similar, if not identical, pathways; therapeutic effect may be due to a combination of D2 and 5-HT2A receptor antagonism. Paliperidone also has antagonist effect at α1 and α2 adrenergic receptors and at H1 histamine receptors. Other indications may involve bipolar mania and schizoaffective disorder, and like risperidone, its possible use in autism and Asperger's syndrome and Tourette's disorder may be of benefit to the patients. Risperidone was initially marketed as Risperdal and recently became generic.
Paliperidone recently received marketing approval as the first oral atypical antipsychotic with an extended release, which is achieved by an osmotic-controlled release oral delivery system. Paliperidone ER (WO-A 2006/017537) is marketed as Invega Sustenna. Unsaturated derivatives thereof are described in WO-A 2008/128436.
Other extended release oral dosage forms for paliperidone are under development. Due the presence of a secondary hydroxyl group, paliperidone may be provided as a prodrug. WO-A 2009/015828 details acid-labile low molecular weight prodrugs of paliperidone intended to undergo hydrolysis in the stomach.
It is of interest to develop very long-acting, injectable depots of paliperidone. There is great need to improve the compliance factor particularly in the treatment of schizophrenia. The development of once-weekly or even longer acting injectable depot formulations of paliperidone will mark a significant step forward to ensure continuous and steady supply of the effective medication.
In U.S. Pat. No. 5,965,168 is described compounds of formula I which are formulated in sustained release microparticles. Risperidone is mentioned as the preferred compound and risperidone is used as basis for all experimentals therein. FIG. 5 therein shows the plasma concentration time curves for the active moiety (sum of risperidone and paliperidone) after intramuscular injection of risperidone depot.
WO-A 2008/153611 describes sustained release formulations of risperidone and metabolites. Here, risperidone is mixed with a soluble thermoplastic polymer, forming an encapsulating residue upon injection from which risperidone is slowly released.
U.S. Pat. No. 5,254,556 reveals ester-linked prodrugs of paliperidone. The substance paliperidone palmitate is approved as a once monthly atypical antipsychotic intramuscular injection for treating schizophrenia and preventing recurrence of its symptoms. Paliperidone palmitate is formulated in a submicrocrystalline form.
Paliperidone palmitate due to its dissolution rate-limited absorption exhibits flip-flop kinetics, where the apparent half-life is controlled by the absorption rate constant. Additionally the volume of injected drug product also impacts the apparent rate constant. It was also discovered that deltoid injections result in a faster rise in initial plasma concentration, facilitating a rapid attainment of potential therapeutic concentrations. Consequently, to facilitate patients' attaining a rapid therapeutic concentration of paliperidone it is preferred to provide the initial loading dose of paliperidone palmitate in the deltoids. The loading dose should be from about 100 mg-eq. to about 150 mg-eq. of paliperidone provided in the form of paliperidone palmitate. After the first or more preferably after the second loading dose injection patients will be approaching a steady state concentration of paliperidone in their plasma and may be injected in either the deltoid or the gluteal muscle thereafter. However, it is preferred that the patients receive further injections in the gluteal muscle. US-A2009/0163519 outlines corresponding dosing regimen for long-acting injectable paliperidone esters of the palmitate type.
Other antipsychotic depot medications are also characterized by the need for concomitant oral medication or booster injections in order to obtain desired plasma levels of the active drug. For example, Risperdal Consta requires oral antipsychotic treatment during the initiation phase.
A preferred profile of a depot antipsychotic would be dosing once a month or even less frequent, without the need for additional oral or injectable medication. It would therefore be a significant step forward if a sustained release atypical antipsychotic formulation could also be characterized by having a fast onset. It is therefore an object of the current formulation to provide a long acting formulation in which the therapeutic plasma concentration is attained within the first 24 hours after dosing.
Though the gluteal muscle is the preferred site for paliperidone palmitate administration, there is a perception in the psychiatric community that injection in the gluteal muscle is psychologically distressing to the patients as well as intramuscular injection in general being associated with significant physical discomfort.
It would therefore be of benefit for the patient as well as the health care professional that the long acting depot could be administered by subcutaneous injection, which is perceived less painful and less invasive.
Paliperidone esters are not the only antipsychotic compounds being associated with complications following intramuscular injection. A novel long acting version of olanzapine, Zypadhera, is associated with a serious phenomenone of rapid absorption of the depot drug occurring in approximately 1 out of every 1000 injections. The phenomenone, post-injection delirium/sedation syndrome, is thought to relate to faster dissolution of the depot if a blood vessel is damaged or the drug is administered to a capillary bed during administration and thereby increasing blood flow near the depot and hence also increase the dissolution rate. This phenomenone potentially can occur with depots where the release profile of the drug is controlled in large part by surrounding blood flow. It is well described that this phenomenone is known risk of intramuscular injections (drugs. 2008; 68(16), 2269-92).
Therefore, it would be beneficial to have a long acting atypical antipsychotic formulation that can be administered by subcutaneous injection and that does not display large variation in absorption between injection sites. This would allow the health care professional to choose between preferred injection sites without increasing the variation of the plasma concentration of active drug as well as causing the patient minimal discomfort. Subcutaneous injection would also be perceived as significantly less invasive by patient and physician.
In addition, a formulation without the risk of post-injection delirium/sedation syndrome would greatly increase safety for the patients and reduce health care costs as the need for post injection patient monitoring is reduced.
An additional positive feature of administering subcutaneous injections is a reduced need for different needles dimensions for patients with differing body mass index (BMI). For example, according to the prescribing information for Invega® Sustenna™, different needle sizes are required for ensuring delivery of the depot to the muscular tissue in patients with varying amounts of subcutaneous fat.
Furthermore, studies of the long-acting injectable formulation of risperidone, which is dosed every two weeks, have indicated that D2-receptor occupancy remains relatively stable throughout the dosing interval, and this has been associated with low rates of rehospitalization in patients with schizophrenia, as well as a reduced risk of extrapyrimidal symptoms (EPS). It may, therefore, be desirable to achieve a stable plasma profile and, consequently, consistent D2-receptor occupancy throughout the day. Long acting atypical antipsychotic depots, therefore, offer advantages over oral dosing regimens, the latter being characterized by having larger variations in peaks and troughs in plasma concentrations. Long acting atypical antipsychotic depots therefore can reduce the incidence of EPS and/or sub-optimal efficacy. For this reason it is beneficial to have a small ratio between peak and trough plasma concentration, preferably less than 3 at steady state.
It is noted that in this disclosure and particularly in the claims and/or paragraphs, terms such as “comprises”, “comprised”, “comprising” and the like can have the meaning attributed to it in U.S. Patent law; e.g., they can mean “includes”, “included”, “including”, and the like; and that terms such as “consisting essentially of” and “consists essentially of” have the meaning ascribed to them in U.S. Patent law, e.g., they allow for elements not explicitly recited, but exclude elements that are found in the prior art or that affect a basic or novel characteristic of the invention.
It is further noted that the invention does not intend to encompass within the scope of the invention any previously disclosed product, process of making the product or method of using the product, which meets the written description and enablement requirements of the USPTO (35 U.S.C. 112, first paragraph) or the EPO (Article 83 of the EPC), such that applicant(s) reserve the right to disclaim, and hereby disclose a disclaimer of, any previously described product, method of making the product, or process of using the product.